Lack of efficacy of an intradural nerve anastomosis for bladder control

Chinese urologist C. G. Xiao has published extensively on an intradural nerve root transfer procedure reported to improve urinary continence and voluntary bladder control in patients with spinal cord injuries and spinal dysraphism. This month, Tuite et al report the results of a double blinded, placebo controlled, randomized control trial of this operation in patients with myelomeningocele and lipomyelomeningocele.

Included patients were undergoing spinal cord detethering operation for the usual indications. Patients were randomized intraoperatively to undergo either dethethering alone or detethering plus the Xiao procedure. Patients/families and evaluators were blinded to the treatment received.

No patient in either group was able to void in response to skin scratching (the stimulus reported by Xiao to initiate micturition). No patient in either group was continent of urine before surgery or any time after surgery. Bladder contractions in response to skin scratching occurred in patients in both groups, before and after surgery, but with no difference in frequency between the groups.